Updated Medicare Insulin Options for 2023
By Natalie Sainz
The Centers for Medicare and Medicaid Services has created a Special Enrollment Period for people with insulin to change their Part D coverage and ensure they are not paying more than $35 each month for the insulin product.
In response to new legislation and falling prices, there have been several significant changes to Insurance coverage for insulin.
Last fall, President Joe Biden signed the Inflation Reduction Act which included policies that cap the monthly cost of insulin at $35 and reduce the cost of other diabetes drugs for those on Medicare.
Here’s what’s now in effect.
Caps on insulin costs
As of Jan. 1, 2023, Medicare can’t charge you more than $35 for a one month supply of each Part-D covered insulin, regardless of whether or not you have met the deductible.
*Note: Medicare Part D is Medicare’s prescription drug coverage. This includes several diabetes drugs and insulins – including Lantus, Jardiance, Novolog, and Trulicity.
If you use a disposable insulin patch pump, you’ll continue to get your insulin through your part D plan, and the insulin for your pump won’t cost more than $35 each month for each covered insulin product. The pump is not subject to the $35 cap and may cost more than $35.
If you do pay more than $35 for any month’s supply of insulin between January 1, 2023, and March 31, 2023, your Part D plan must reimburse you within 30 calendar days for the amount you overpaid. (Plans have until March 31, 2023 to update their systems to make sure you’re not charged more than $35).
Extended enrollment period for Medicare Part D coverage
The Medicare Plan Finder can help you compare and choose prescription drug plans. However, because the Inflation Reduction Act was signed after the premiums and copays were set on the Medicare Plan Finder, the $35 insulin copay cap was not included.
Because of this, the CMS created a Special Enrollment Period for people who use insulin; people on Medicare can change their Part D coverage until Dec. 31, 2023.
If you use a covered insulin product and decide you’d like to be in a different Part D plan for 2023, you can change your coverage one time between now and December 31, 2023. Call 1-800-MEDICARE if you take insulin and want to change your plan. Your true out-of-pocket costs will carry over from your old plan to your new one.
Low-income benefits
Medicare beneficiaries who make between 135% and 150% of the federal poverty level ($18,347 to $20,385 for a single person) can access additional discounts through the Extra Help program. Starting in 2024, people who are eligible will have a set, low out-of-pocket cost for each prescription. This could save people an average of $300 a year on out-of-pocket costs, according to government estimates.
For more information on how the Inflation Reduction Act could lower healthcare costs in your state, click here.
You can also learn more about Medicare’s coverage and insulin costs at https://www.medicare.gov/coverage/insulin.
